Outline

A randomized controlled trial was conducted in cooperation with the Departments of General Surgery and Medical Psychology, University Hospital of Hamburg, Germany from 1/1991 – 12/1992. Two hundred and seventy-one consenting patients with a preliminary diagnosis of cancer of the esophagus, stomach, liver/gallbladder, pancreas or Colon/rectum were stratified by gender and randomly assigned to a control group that received standard care as provided on the surgical wards, or to an experimental group that received formal psychotherapeutic support in addition to routine care during the hospital stay. From 6/2003 to 12/2003 the 10-years-Followup was conducted. Survival status of all 271 patients could be determined using three data sources: the german cancer registry, the family doctors and the general citizen registration offices. Kaplan-Meier survival curves demonstrated better survival for the experimental group than the control group. The unadjusted significance level for group differences was 0=0.0006 for survival to ten years. Cox regression models that took TNM Staging or the Residual Tumor Classification and site of tumor into account also found significant differences at the ten year follow up. Secondary analyses found that most of the differences in favor of the experimental group occurred in females and in the patients with stomach, pancreatic, primary liver or colorectal cancer. The results of this study indicate that patients with gastrointestinal cancer, particularly those who are female and those who undergo surgery for stomach, pancreatic, primary liver or colorectal cancer, benefit from a formal program of psychotherapeutic support during the in-hospital stay in terms of survival.